Sofer D, Regenbrecht B, Pfeil J
Chirurgische Klinik II, Unfall- und Wiederherstellungschirurgie, Klinikum Darmstadt, Darmstadt.
Orthopade. 2005 Jun;34(6):592-602. doi: 10.1007/s00132-005-0780-2.
Periprosthetic infections will generally require revision arthroplasty. The one-stage revision arthroplasty with antibiotic-laden cement is hence an attractive therapeutic option, since it only requires one operation, has a low morbidity and, if successful, is cost-efficient.
We performed one-stage revision arthroplasties. The exchanged prostheses were fixed with antibiotic-laden cement after biotic resistance was determined. All patients were treated with postoperative systemic antibiotics.
After a mean postoperative examination period of 18.4 months, we confirmed eradication of infection in 14 of 15 knee joints and in 15 of 16 hip joints. The mean duration of hospital stay was 23 days. Patients' satisfaction was high (93.55%) and the clinical results were satisfactory.
Our analysis shows that our low early reinfection rate (6.45%) is within statistical expectation. Furthermore, we have showed that there is evidence to suggest that the rate of successful outcomes in one-stage revision arthroplasties, at least at the hip, is not different from the rate of two-stage revision arthroplasties and that the difference may be interpreted as stochastic deviation (p=0.264494). According to existing studies, an analogy to knee arthroplasties can be assumed. We demonstrated that one-stage revision is an adequate therapeutic option if patients are carefully selected and under the supervision of an experienced surgeon.
人工关节周围感染通常需要进行关节置换翻修手术。因此，使用含抗生素骨水泥的一期关节置换翻修手术是一种有吸引力的治疗选择，因为它只需要一次手术，发病率低，而且如果成功，成本效益高。
我们进行了一期关节置换翻修手术。在确定生物抗性后，用含抗生素骨水泥固定更换的假体。所有患者术后均接受全身抗生素治疗。
术后平均检查期为18.4个月，我们证实15个膝关节中的14个以及16个髋关节中的15个感染已消除。平均住院时间为23天。患者满意度较高（93.55%），临床结果令人满意。
我们的分析表明，我们较低的早期再感染率（6.45%）在统计学预期范围内。此外，我们已表明，有证据表明一期关节置换翻修手术的成功结果率，至少在髋关节方面，与二期关节置换翻修手术的成功率没有差异，且这种差异可解释为随机偏差（p = 0.264494）。根据现有研究，可以假定膝关节置换手术也类似。我们证明，如果仔细选择患者并在经验丰富的外科医生监督下，一期翻修是一种合适的治疗选择。
